8/2/2019 Acute Abdomen. 14.03.11

1/16

ACUTE ABDOMEN

Acute Appendicitis &

Its Complication

8/2/2019 Acute Abdomen. 14.03.11

2/16

Acute Abdomen

Definition:

It encompasses many diverse

entities except traumatic causewhich is urgent is nature and may

or may not require surgical

intervention.

8/2/2019 Acute Abdomen. 14.03.11

3/16

Acute Appendicitis

Introduction:1. Appendicectomy is the most frequently

performed urgent abdominal operation.

2. It is often the first major procedureperformed by surgeon in training.

3. With all advancement of diagnosticlaboratory investigations the diagnosis ofappendicitis remains essentially clinical,requiring a mixture of observation, Clinicalacumen and surgical science.

8/2/2019 Acute Abdomen. 14.03.11

4/16

Anatomy:1. Present only is human, certain

anthropoids.

2. It is undeveloped distal segment oflarge caecum.

3. Layers, length lumen, blood supply.

4. Position of appendix5. Histology.

Acute Appendicitis

8/2/2019 Acute Abdomen. 14.03.11

5/16

Incidence:1. In the developed countries it is estimated

that 10% of the population but now it isdeclining and around 6-8%.

2. Rare is infants, common in early childhood.

3. Peak incidence- early 20s.

Male: Female = before puberty in teen age &young adult 3:2

Acute Appendicitis

8/2/2019 Acute Abdomen. 14.03.11

6/16

Aetiology:

1. No definite cause.

2. Decrease dietary fibre and increasedconsumption of refined carbohydratesassociated with this condition.

3. Bacterial proliferation.

4. Obstruction to the lumen-

Faecolith

Lymphoid hyperplasia

Acute Appendicitis

8/2/2019 Acute Abdomen. 14.03.11

7/16

5. Extreme of age

6. Immunosuppresion.7. DM.Risk factors for perforation of the appendix:

1. Extremes of age2. Immunosuppression3. Diabetes mellitus

4. Faecolith obstruction5. Pelvic appendix6. Previous abdominal surgery.

Acute Appendicitis

8/2/2019 Acute Abdomen. 14.03.11

8/16

Symptoms of appendicitis : Peri- umbilical colic

Pain shifts to the right iliac fossa

Anorexia

Nausea.

Signs: Pyrexia

Localized tenderness in right iliac fossa

Muscle guarding

Rebound tenderness.

Clinical Features

8/2/2019 Acute Abdomen. 14.03.11

9/16

Signs to elicit in appendicitis:

Pointing sign

Rovsings sign

Psoas sign

Obturator sign.

Clinical features

8/2/2019 Acute Abdomen. 14.03.11

10/16

Differential diagnosis of acute appendicitis

Children AdultGastroenteritis Regional enteritisMesenteric adenitis Ureteric colic

Meckels diverticulitis Perforated peptic ulcer

Intussusception Torsion of testis

Henoch schonleinpurpura

Pancreatitis

Lobar pneumonia Rectus sheathhaematoma

8/2/2019 Acute Abdomen. 14.03.11

11/16

Adult female Elderly

Mittelschmerz Diverticulitis

Pelvic inflammatorydisease

Intestinal obstruction

Pyelonephritis Colonic carcinoma

Ectopic pregnancy Torsion appendixepiploicae

Torsion/rupture ofovarian cyst

Mesenteric infarction

Endometriosis Leaking aortic aneurysm

Differential diagnosis of acute appendicitis

8/2/2019 Acute Abdomen. 14.03.11

12/16

Symptoms Score

Migratory RIF pain 1

Anorexia 1

Nausea and vomiting 1

Signs

Tenderness(RIF) 2

Rebound tenderness 1

Elevated temperature 1

Laboratory

Leucocytosis 2

Shift to left 1

Total 10

The Alvarado (MANTRELS) Score

8/2/2019 Acute Abdomen. 14.03.11

13/16

ACUTE APPENDICITIS

Investigation:Preoperative investigations in appendicitis:

A. Routine: Full blood count

UrinalysisB. Selective:Pregnancy testUrea and electrolytes

Supine abdominal radiographUltrasound of the abdomen/pelvisContrast- enhanced CT scan of the abdomen.

8/2/2019 Acute Abdomen. 14.03.11

14/16

Management:

1. Management of acute appendicitis

2. Management of appendix abscess

3. Management of appendix mass

ACUTE APPENDICITIS

8/2/2019 Acute Abdomen. 14.03.11

15/16

Post operative Complication:1. Wound infection

2. Intra-abdominal abscess.

3. Ileus.4. Respiratory

5. Venous thrombosis

6. Faecal fistula7. Intestinal obstruction

ACUTE APPENDICITIS

8/2/2019 Acute Abdomen. 14.03.11

16/16

Other Condition of appendix:1. Mucocele of appendix.

2. Carcinoid tumour3. Primary adenocarcinoma.

Acute Appendicitis